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Rheum Views on the Upside and Downside of COVID-19

d Jack Cush, MD

The world has been turned upside down in the last 6 weeks. Medicine and rheumatology have certainly changed – a frightening experience for Chicken Little, a disaster for the pessimist, a challenge for the pragmatist and an opportunity for the optimists amongst us. Last week I asked our audience to tell me their “upside or downside of COVID-19”. Read on to see how your peers have operating or thinking.

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Rare Inflammatory Syndrome in Kids with COVID-19

d Jack Cush, MD

Pediatricians are asking the question - could this be a rare manifestation of COVID-19 in children?

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IL-6 Inhibitors May Benefit COVID-19 Infection

d Jack Cush, MD

In the last few days there have been encouraging "preliminary" reports that IL-6 inhibition by either tocilizumab or sarilumab may be efficacious in patients with severe coronavirus infections.

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TNF Inhibitors Reduce and Stabilize Coronary Plaque

d Jack Cush, MD

Arthritis & Rheumatology reports that biologic (bDMARD) use in rheumatoid arthritis may decrease cardiovascular disease risk by retarding coronary plaque formation and progression (especially non‐calcified and low‐attenuation plaque).

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High Dose Chloroquine Harmful in Severe COVID-19

d Jack Cush, MD

JAMA Open Network reports an interim analysis of the Brazilian CloroCovid-19 trial showing thta higher doses of chloroquine (CQ) in the treatment of severe COVID-19 was associated with QTc interval prolongation and increased mortality.

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RheumNow Podcast – In Times of Trouble (4.24.20)

d Jack Cush, MD

Dr Jack Cush reviews the news, journal reports, twitter feed and COVID developments from the past week on RheumNow.com

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HCQ fails to prevent severe COVID19 in 17 SLE pts (w/ CKD, GN, APL, 12 pred, 7 on immunosuppressants).14 hospitalized, 13 viral pneumonia, 11 respiratory failure, 5 ARDS; 3 ARF. Despite good HCQ levels, 2 died, 5 on ventilator, 36% D/C, 1/2 still hosp. https://t.co/e0qLGtF6Nj

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Dr. John Cush RheumNow ( View Tweet)

“It does not matter how slowly you go as long as you do not stop.” ― Confucius

Dr. John Cush RheumNow ( View Tweet)

French retrospective study of 429 pts (302 SpA, 127 PsA) compared 203 on TNF inhib mAb vs 226 on etandercept as 1st TNFi. The probability of uveitis during the 1st yr was lower with ETA but not signif different than mAbs (OR 0.94; 0.35; 2.54) https://t.co/jCSxL0hh7H https://t.co/cCSyVqgd6w

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Dr. John Cush RheumNow ( View Tweet)
Matched case control study of 94 SLE patients with diffuse alveolar hemorrhage finds Lupus nephritis, +SSA, thrombocytopenia & high CRP were independent risk factors for DAH. SLE-DAH pts had signif higher mortality (adjHR 6.0; 2.8–13.0). https://t.co/OUtSqXTGnw https://t.co/3myioyHqvc

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Dr. John Cush RheumNow ( View Tweet)
"Permanence, perseverance and persistence in spite of all obstacles, discouragements, and impossibilities: It is this, that in all things distinguishes the strong soul from the weak." - Thomas Carlyle

Dr. John Cush RheumNow ( View Tweet)

Health Canada issued a safety alert noting Chloroquine & hydroxychloroquine can have serious toxicities & should only be used under a physicians supervision. Due o concern that some may be directly buying/using CQ/HCQ to treat/prevent COVID-19 https://t.co/ksxveHADZX

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Dr. John Cush RheumNow ( View Tweet)

Sanofi announced early results of phase 2 trial of IL6 inhibitor, sarilumab, showing benefit only in Critical COVID-19 pts. 457 pts given IV Kevzara 400 mg vs 200 mg vs PBO , high dose had fewer deaths (32 v 46 v 55%) & more D/C (53 v 39 v 41%). https://t.co/6q21qJNj2C

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Dr. John Cush RheumNow ( View Tweet)

On April 24, FDA issued a Drug Safety Communication stating HCQ and CQ have not been shown to be safe and effective in COVID-19 and that HCQ/CQ should not be used outside of hospitalized or pts in clinical trials. https://t.co/l2DNBhhvTR

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Dr. John Cush RheumNow ( View Tweet)

Informative, straight forward, well done video of the SHOULDER Exam! https://t.co/AQetQjvQP1

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Dr. John Cush RheumNow ( View Tweet)

"Quantity and persistence will get you the outcomes you need." - James Altucher

Dr. John Cush RheumNow ( View Tweet)

The RheumNow Podcast is up! "In times of Trouble". Watch it here>> https://t.co/gapTwq3REW or listen to the podcast on iTunes or SoundCloud>> https://t.co/dpoCoX8qBR

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Dr. John Cush RheumNow ( View Tweet)

"Yeah, you might beat me today, but then you’re gonna have to fight me again tomorrow and the day after that and every single day from now on until I kick the #$%! out of you, which I will.” - William Costanzo

Dr. John Cush RheumNow ( View Tweet)

The RheumNow Podcast is up! "In times of Trouble". ABA and DM, Zostavax fails, 3d Doubling rate, population testing, HCQ in COVID; Watch it here>> https://t.co/gapTwq3REW or listen to the podcast on iTunes or SoundCloud>> https://t.co/dpoCoX8qBR

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Dr. John Cush RheumNow ( View Tweet)

"Stay in your seat come times of trouble. Its only people who jump off the roller coaster who get hurt." - Paul Harvey

Dr. John Cush RheumNow ( View Tweet)

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